Atypical antipsychotics are the treatment of choice for psychotic symptoms in dementia. Despite the consistent results present in the literature up to this point, various antipsychotics remain insufficiently studied and would need more generous sample sizes for their outcomes to be substantiated.Minimally invasive plate osteosynthesis is a surgical technique that is becoming increasingly common because radiographic images and implant technologies advance in capabilities. It is imperative for surgeons to enhance their understanding of the surgical anatomy related to new approaches for fracture fixation. While performing minimally invasive plate osteosynthesis, there is a danger of injuring structures in the common percutaneous and submuscular pathways. We describe the critical anatomical structures in these pathways and tips for injury avoidance when operating on the clavicle, scapula, humerus, and wrist.

The United States is experiencing a national opioid epidemic. This study seeks to analyze recent trends in opioid claims after elective total joint arthroplasty and quantify the effect of preoperative opioid use on risk of prolonged postoperative claim rates.

A retrospective cohort study was conducted using the PearlDiver database to track annual trends in opioid claims after elective total hip arthroplasty (THA), total knee arthroplasty (TKA), and total shoulder arthroplasty (TSA). Trend analysis of opioid claim rates was done with the Cochran-Armitage test. Rates of postoperative opioid claims were compared between opioid-naïve patients versus patients with opioid claims in the preoperative year through multivariable logistic regression.

In total, 105,860 procedures were included. For all procedures, the proportion of patients filing an opioid claim within 30 days postoperatively trended upward from 2011 to 2017 (all P < 0.001). Patients with one to three opioid claims in the year before arthroplasty were more likely to file an opioid claim within 30 days after arthroplasty (THA odds ratio [OR], 2.61; TKA OR, 3.04; and TSA OR, 4.83), between 31 and 90 days (THA OR, 2.76; TKA OR, 2.87; and TSA OR, 3.22), and between 91 days and 6 months (THA OR, 4.83; TKA OR, 4.07; and TSA OR, 3.77). Proteasome assay Patients with more than three prior opioid claims were more likely to file an opioid claim within 30 days (THA OR, 6.15; TKA OR, 6.79; and TSA OR, 8.68), between 31 and 90 days (THA OR, 20.99; TKA OR, 14.00; and TSA OR, 28.40), and between 91 days and 6 months (THA OR, 46.31; TKA OR, 33.93; and TSA OR, 59.06).

Opioid claims in the preoperative year markedly increase risk of prolonged postoperative opioid claims after arthroplasty. Surgeons should look further before the acute preoperative period when evaluating opioid exposure and assessing risk of chronic opioid dependence after elective arthroplasty.

Level III.

Level III.The majority of coronavirus disease 2019 (COVID-19) have been confirmed in adults, with only a few reported cases in children. In the pediatric population, COVID-19 infection appears to be often unremarkable or associated with mild respiratory symptoms. Little is known about neurologic complications related to COVID-19 in newborns. We present a case of severe encephalitis with cytotoxic brain edema in a newborn with COVID-19.Coronavirus disease 2019 (COVID-19) symptoms in newborn infants are incompletely described. We present the first case of neuroradiologic abnormality associated with COVID-19 in a newborn infant with afebrile seizure. This case underlines the possible neurologic involvement of severe acute respiratory syndrome coronavirus 2 in this age group.

Infective endocarditis (IE) is a rare entity in children associated with significant morbidity and mortality. To optimize management, it is important to understand local epidemiology, risk factors, clinical features and outcome. These are investigated in this retrospective 10-year study of endocarditis in children in Queensland.

Children <18 years with IE were identified from the state-wide pediatric cardiology center (Mater Children’s Hospital, 2009-2014; Queensland Children’s Hospital, 2014-2018) through International Classification of Diseases codes and local cardiology database. Clinical records were assessed by a clinician and echocardiograms by a cardiologist. Incidence was calculated using Australian Bureau of Statistics Queensland Estimated Resident Population data, 2019.

Fifty-one children were identified, with an overall estimated incidence of 0.84 per 100,000 per year; 0.69 per 100,000 in 2009-2013 and 0.99 per 100,000 in 2014-2018, respectively. Twenty-four (47.1%) children were male and than the reported incidence in New Zealand and the United States. Congenital heart disease is the most common risk factor and S. aureus is the commonest responsible organism. Aboriginal or Torres Strait Islander children are over-represented. Mortality remains low.In England, the easing of national lockdown in response to the coronavirus disease 2019 pandemic included the reopening of some primary school years on June 1, 2020. National surveillance did not identify any increase in the year groups attending school. Most children had a severe acute respiratory syndrome coronavirus 2 positive household contact. Hospitalizations for coronavirus disease 2019 were rare, but 2.7% (7/259) had persistent symptoms 1 month later.We describe the successful treatment of a 10-month-old female with respiratory distress secondary to Coronavirus disease 2019 (COVID-19) with the nebulized investigational drug, DAS181. Therapy was well tolerated, and the patient had minimal side effects. The patient’s respiratory distress and positive viral polymerase chain reaction rapidly resolved after initiation of therapy.Neurologic manifestation of coronavirus disease 2019 (COVID-19) in children is evolving with time. We are reporting a young girl who presented to us with acute febrile illness followed by acute onset severe flaccid paralysis requiring prolonged intensive care unit stay and ventilator support. She was evaluated extensively and found to be positive for COVID serology, and neuroimaging revealed features of longitudinally extensive transverse myelitis (LETM) with enhancing cauda equina nerve roots, suggesting Guillain-Barré Syndrome (GBS). She failed to respond to immune suppressive therapy and needed plasma exchange for recovery. Like other common viral illnesses, COVID-19 can also act as a trigger for GBS-like illness and LETM, and we need to suspect these diagnoses in the cases with COVID-19 infection in compatible cases. This is probably the first pediatric case with concurrent GBS and LETM secondary to COVID-19 infection.